Table 1.

Study design

Qualitative approach	Phenomenology
Research paradigm	Constructivism
Setting	Study developed in a research group seeking to develop the use of qualitative research in adolescent psychiatry
Ethical issues	The relevant French Institutional Committee of the Paris North University Hospital Group approved this study All patients and their parents provided written consent before inclusion
Sampling strategy	Purposive sampling strategy: selective and deliberate
	Researchers first contacted clinicians at recruitment sites (Argenteuil and Remiremont Hospitals) where recruitment was planned and explained the study design and objectives to them in detail
	Clinicians identified potential participants—adolescents and parents—whom they considered most likely to provide useful information
	Clinicians mentioned the study to potential participants and gave them an information sheet about it
	Researchers met each interested teen and his/her parents
	To describe the study
	To collect social and demographic data
	To obtain their written consent
Inclusion/exclusion criteria	Adolescents between 12 and 18 years at the time of the interview
	Adolescents and parents must speak French fluently
	Adolescents must not have an eating disorder (i.e., anorexia nervosa, bulimia, avoidant/restrictive food intake disorder, or another unspecified eating disorder) or a weight-related disorder such as obesity
	Adolescents could have food-related symptoms and their effects on the family relationships would be part of our field of exploration
	Adolescents must not present acute or severe psychiatric disorders—schizophrenia, bipolar disorder, or autistic spectrum disorders—(the focus of this study was not the adolescents’ psychopathology but rather the relevance of photo-elicitation in research in adolescent psychiatry)
	Families must not have major dysfunctional patterns, such as neglect or abuse
	Adolescents must be able to talk about their experience of family relationships around food and the family meal
	Adolescents must have been receiving care for at least 6 months
Participants	Adolescents receiving psychiatric care in an outpatient setting and one or both of their parents
	All saw their psychiatrist at least once a month
	All had chronic mental disorders that had begun during adolescence (depression, anxiety, social phobia, personality disorder). This diagnosis was made by each patient’s referring psychiatrist, according to DSM 5 criteria
	None had a somatic disease
Data saturation	Data saturation according to the principle of theoretical sufficiency:
	When new participants were not adding anything significant to the database
	When the themes obtained offered a sufficient explanatory framework in view of the data collected
	Two further individual interviews were conducted with no new themes emerging, to ensure full data saturation
Data collection period	From April 2015 to November 2015
Data collection methods	Individual in-depth interviews using photo-elicitation:
	At the end of the preliminary interview, the adolescent was given a digital camera. They could refuse and use their own equipment (smartphone) if they preferred
	Instructions: “You must take a photograph of the table after a family meal. The table should not yet have been cleared. No person should appear in the picture, so everyone at the table must have gotten up. You can take as many pictures as you want, but you will have to choose just one that you will talk about with the researcher at the interview”
	We chose to ask for a photo after the family meal to encourage a narrative of the entire meal
	For ethical reasons, no person could appear in the photographs
	Individual interviews a week after:
	Of the adolescent and immediately after of the parent(s)
	The selected photograph was displayed on a computer screen during both interviews
	The interviewer began by asking the adolescent for a description of the family meal from which the photograph resulted
	At any point during the interview, the interviewer and the participant could go back to the photograph
	Individual in-depth interviews:
	Unstructured, open-ended approach
	One introductory prompt: “can you tell us about this family meal?”
	To get rich and detailed personal data from each participant
	To enter the interviewees’ psychological and social world
	To remain open and attentive to any unknown issues that they might introduce
	All interviews were:
	Audio-recorded with participants’ permission
	Transcribed word for word, including nonverbal aspects (pauses, laughter, etc.)
	Anonymized
Interviewers	The same researcher (JS), an adolescent psychiatrist, conducted all the interviews
Duration of the interviews	From 60 to 90 min
Data analysis	Thematic analysis:
	To identify, analyze and report themes within data
	To identify the similarities and the differences in the participants’ narratives
	To discern recurrent patterns and to integrate new elements that emerged from the analysis
	In a data-driven analysis with inductive approach = coding the data without any reference to theoretical notions or researcher’s preconceptions
Criteria to ensure validity	Analysis conducted independently by the three researchers (JS, EC, LP)
	To verify that the themes identified were an exact reflection of the data
	Research group monthly meetings:
	To discuss the results
	To be supervised by a researcher more distant from the material (ARL)
	To resolve disagreements on the inclusion or exclusion of a theme (discussion continued until a consensus was reached)